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1 EMBASSY OF INDIA 2536 MASSACHUSETTS AVE NW WASHINGTON DC Tel. Ph. (202) VISA APPLICATION FORM FOR PAKISTANI NATIONALS [ To be filled in QUADRUPLICATE (4) ] ( FOR OFFICIAL USE ONLY ) Granted Visa No. Dated Valid For Single Journey to INDIA within Valid for stay at Places specified below for Days Days Place District/ Place District/ State State i) iv) ii) v) iii) vi) Visa Officer Checkpost of : (1) Entry into INDIA: ATTARI/BOMBAY/DELHI/CHENNAI (2) Exit from INDIA: ATTARI/ BOMBAY/ DELHI / CHENNAI Holder Accompanied by Children. To Be Completed by the Applicant 1. Name in Full (In BLOCK letters) 2. Address: (House No/Village/City/Thana/Tehsil/Distt/Province) i) Present (Tel. No.) ii) Permanent 3. a) Father / Husbands Name (In Full) Nationality (Tel. No.) Occupation ATTACH PHOTOGRAPH HERE Address

2 4. DATE OF BIRTH 5. PLACE OF BIRTH 6. RELIGION 7. NATIONALITY 8. (i) DISTINGUISHING MARKS (AS DESCRIBED IN PASSPORT) (ii) COLOR OF (a) EYES (b) HAIR (c) HEIGHT 9. (iii) PRESENT OCCUPATION IN DETAIL (WITH DESIGNATION, RANK, DEPARTURE, NAME OF EMPLOYER OR IF IN BUSINESS, THE NATURE OF THE BUSINESS) 10. PAST OCCUPATION 11. VISA APPLIED FOR (i) [DURATION] (ii) [COMMENCING FROM] 12. PLACES OF VISIT (OR BREAK OF JOURNEY IN CASE OF TRANSIT VISA) AND ADDRESSES OF RELATIVES. Name Relation FATHER S/ HUSBAND S NAME HOUSE NO STREET MOHALLAH VILLAGE/ TOWN POST OFFICE POLICE STATION/ TEHSIL DISTRICT/ STATE Whether place is in Cantonment Area Put (YES OR NO) NOTE: ON LINE NO.1 THE APPLICANT SHOULD MENTION ONLY THAT PLACE WHICH HE WOULD REACH FIRST IN INDIA. NO REQUEST FOR A CHANGE OF THIS PLACE WILL BE ENTERTAINED AT A LATER STAGE. 13. CHECKPOST OF (1) ENTRY IN INDIA: ATTARI / BOMBAY(MUMBAI) / DELHI / CHENNAI (2) EXIT FROM INDIA: ATTARI/ BOMBAY(MUMBAI) / DELHI / CHENNAI (PLEASE SEE INSTRUCTION NO. 4 (PORT OF ENTRY AND EXIT SHOULD BE THE SAME PLACE) 14. CHILDREN IF ANY, ACCOMPANYING THE APPLICANT: NAME SEX DATE OF BIRTH (i) (ii) (iii) (iv)

3 15. NAME, PARENTAGE AND ACCURATE ADDRESS OF AT LEAST TWO PERSONS IN INDIA TO WHOM THE APPLICANT HAS KNOWN: (i) NAME PARENTAGE ADDRESS (ii) NAME PARENTAGE ADDRESS 16. (a) INTERNATIONAL/ SPECIAL PAKISTAN PASSPORT HELD: NO AT ISSUED ON WITH ENDORSEMENT FOR JOURNEY TO INDIA VALID UP TO (b) DETAILS OF ANY OTHER PASSPORT PREVIOUSLY HELD, AND IF SO, WHETHER PASSPORT(S) RENEWED / LOST ETC.. NO(s) ISSUED AT ON (c) ANY OTHER FOREIGN PASSPORT / IDENTITY CERTIFICATE HELD COUNTRY OF ISSUED PASSPORT (s) DATE OF ISSUE NATIONALITY/STATUS DESCRIBED THEREIN 17. OBJECT OF VISIT (GIVE DETAILED INFORMATION INCLUDING ORIGINAL SWORN AFFIDAVIT FROM RELATIVES IN INDIA) 18. HAS PERMISSION TO VISIT OR TO EXTEND STAY IN INDIA PREVIOUSLY BEEN REFUSED? IF SO, BY WHOM? (MENTION CONTROL NO AND DATE ALSO) 19. DETAILS OF LAST VISIT: CATEGORY, DATE AND OFFICE OF ISSUE OF VISAS PREVIOUSLY HELD, IF ANY 20. DETAILS OF PREVIOUS PENDING APPLICATION OR UNAVAILED VISA, IF ANY (WITH CONTROL NO. AND DATE) 21. FOR TRANSIT VISAS ONLY: (i) PLACE OF FINAL DESTINATION ( ii) IS PASSPORT VALID FOR THAT COUNTRY? (iii) HAS VISA / IMMIGRATION PERMIT OF THAT COUNTRY BEEN OBTAINED?

4 (iv) THE ADDRESS OF STAY IN BOMBAY / DELHI 22. IF YOU HAVE MIGRATED FROM INDIA TO PAKISTAN OR AFTER 1 ST MARCH 1947, PLEASE STATE: (i) APPROXIMATE DATE OF MIGRATION (ii) ADDRESS IN INDIA BEFORE MIGRATION 23. DO YOU / HAVE YOU PREVIOUSLY BELONG / BELONGED TO MILITARY/ SEMI MILITARY/ POLICE/ SEMI ORGANIZATION? (ANSWER YES OR NO) IF THE ANSWER IS YES, GIVE DETAILS 24. I HEREBY DECLARE THAT ALL THE STATEMENTS AND INFORMATION GIVEN BY ME IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I ALSO DECLARE THAT I HAVE NOT SUBMITTED ANY APPLICATION FOR VISA TO VISIT INDIA UNDER ANY OTHER NAME, SURNAME, MAIDEN NAME ETC., AND THAT THE PASSPORT HELD BY ME AT PRESENT AS INDICATED IN COLUMN 16 IS THE ONLY THAT HOLD, I REALIZE THAT SHOULD ANY OF ABOVE STATEMENTS BE FOUND TO BE FALSE, UNTRUE OR INCORRECT, MY VISA WILL BE LIABLE TO CANCELLATION BY ANY COMPETENT AUTHORITY AND I WILL BE LIABLE TO SUCH OTHER PENALTIES AS MAY BE PRESCRIBED. DATE(dd/mm/yy) / / PLACE SIGNATURE OF APPLICANT INSTRUCTIONS 1. FOUR FORMS ARE TO BE FILLED IN EACH APPLICATION. 2. FORMS WHICH ARE INCORRECTLY FILLED IN OR ARE INCOMPLETE IN ANY RESPECT ARE LIABLE TO BE REJECTED. IF INFORMATION FURNISHED IS FOUND TO BE INCORRECT OR DELIBERATELY WITHHELD, VISA IS LIKELY TO BE REFUSED OR CANCELLED IF ALREADY GIVEN. 3. PLEASE MENTION CLEARLY THE CHECKPOST OF ENTRY INTO/ EXIT FORM INDIA IN COLUMN 13. THE APPLICANTS MAY CHOOSE ANY ONE OF THE FOLLOWING CHECKPOST: BY AIR: ENTRY: BOMBAY (MUMBAI) / DELHI BY SEA: MUMBAI (BOMBAY) EXIT: BOMBAY (MUMBAI) / DELHI / CHENNAI BY ROAD: ATTARI: BY RAIL: ATTRAI RAILWAY STATION

5 4. COPY OF THE FORM RETURNED WITH VISA SHOULD BE SURRENDERED AT THE CHECKPOST OF ENTRY INTO INDIA. 5. REQUIREMENTS: (a) YOUR VALID PASSPORT (b) FOUR PHOTOGRAPHS (c) FEE $20.00 (b) (c) (d) (e) (f) (g) AN ORIGINAL SWORN AFFIDAVIT FROM THE RELATIVES THE APPLICANTS INTEND TO VISIT IN INDIA IS REQUIRED. A LETTER OF FINANCIAL GUARANTEE FROM YOUR BANK TO THE EFFECT THAT YOU HAVE SUFFICIENT FUNDS TO SUPPORT YOU FOR YOUR TRAVEL TO AND STAY IN INDIA. PHOTOCOPY OF YOUR RESIDENT ALIEN CARD OR VISA STATUS IN USA. A LETTER FROM THE TRAVEL AGENCY THAT YOU HAVE BOOKED FOR YOUR PASSAGE TO AND OUT OF INDIA. SELF ADDRESSED STAMPED ENVELOPE WITH ADEQUATE POSTAGE TO COVER MAILING OR $14.00 FOR OVERNIGHT MAILING CHARGES. NO PERSONAL